Medicare Billing: Wheelchairs, Scooters, Lift Chairs at SpinLife

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We understand that the process of submitting claims to Medicare can be difficult and time consuming. To help make the process easier, SpinLife offers what is known as “courtesy billing”. This means that after you purchase an eligible product from SpinLife and request at checkout that we courtesy bill Medicare, we send you all of the documentation required by Medicare for you to complete with your physician. Once medically qualifying documentation is submitted into SpinLife, we can submit a claim to Medicare on your behalf. If your claim is approved by Medicare, they will reimburse you directly for their portion of your claim via mail.
Source: spinlife.com

Medicare Coding & Billing

New Physical Therapy Evaluation and Reevaluation CPT Codes PTs must begin using 3 new evaluation codes and a new reevaluation code beginning January 1, 2017. Now is the time to become familiar with them.
Source: apta.org

Medicare Fee, Payment, Procedure code, ICD, Denial

All In-Office Laboratory Testing and Procedures:    Marked with *, **, ***, ****, and ***** will be limited to one procedure within the same family of asterisks, per visit. Example: All laboratory testing/procedure codes that are marked with one * will only be allowed to have one laboratory test/procedure performed, per visit, out of all of the codes designated with the single *.   Marked with the # symbol will only be considered for reimbursement if the member has an infertility benefit and the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment for additional information related to infertility coverage. CPT Code Description Primary Care Physicians and Specialists 80305 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (e.g., immunoassay); capable of being read by direct optical observation only (e.g., dipsticks, cups, cards, cartridges) includes sample validation when performed, per date of service 80306 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures (e.g., immunoassay); read by instrument assisted direct optical observation (e.g., dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service 81000* Urinalysis, non-automated, with microscopy 81001* Urinalysis, automated, with microscopy 81002* Urinalysis, non-automated, without microscopy 81003* Urinalysis, automated, without microscopy 81025 Urine pregnancy test, by visual color comparison methods  82270***** Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection) CPT Code Description Hematologists/Oncologists/Pediatric Hematologists 85097 Bone marrow; smear interpretation only, with or without differential cell count 86077 Blood bank physician services; difficult cross-match and/or evaluation of irregular antibody(s), interpretation and written report 86078 Blood bank physician services; investigation of transfusion reaction, including suspicion of transmissible disease, interpretation and written report 86079 Blood bank physician services; authorization for deviation from standard bloodbanking procedures, with written report 86927-86999 Transfusion medicine Ophthalmologists and Connecticut CLIA Certified Optometrists Note: Connecticut optometrists may be reimbursed for CPT code 83861 in the office if they are CLIA Certified (Clinical Laboratory Improvement Amendments of 1988 (CLIA)). If no CLIA certification is on file, the service is not eligible for reimbursement. 83861 Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity Ophthalmologists and Optometrists 83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method 87809 Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus Pulmonologists 82803 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation) Rheumatologists 89060 Crystal Identification by light microscopy with or without polarizing lens analysis; tissue or any body fluid (except urine) Urologists  89264# Sperm identification from testis tissue, fresh or cryopreserved 89300 Semen analysis; presence and/or motility of sperm including Huhner test (post coital) 89310 Semen analysis; motility and count (not including Huhner test) 89320 Semen analysis; volume, count, motility and differential 89321 Semen analysis; sperm presence and motility of sperm, if performed 89322 Semen analysis; volume, count, motility, and differential using strict morphologic criteria (e.g., Kruger) REIMBURSEMENT GUIDELINES In-Office Laboratory Testing and Procedures Reimbursement of network physicians for the performance of in-office laboratory testing/procedures is limited to those codes listed on the in-office laboratory testing and procedures list. Reimbursement for some of the Laboratory testing/procedures is limited to certain physician specialties. Refer to the Applicable Codes section below for a list of specific CPT codes.   Marked with a # symbol, will only be considered for reimbursement if the member has an infertility benefit and the provider has the appropriate specialty. Refer to the policy titled Infertility Diagnosis and Treatment for additional information related to infertility coverage. Specimen Handling and Venipuncture CODE 36415 When specimen handling and venipuncture codes are billed; With a laboratory/procedure code on the in-office laboratory testing and procedures list, only the laboratory testing/procedure and venipuncture codes will be considered for reimbursement. Note: The laboratory testing/procedure code will only be considered for reimbursement if the code is listed in the Applicable Codes section of the policy and the provider has the appropriate specialty, if required.   Without a laboratory testing/procedure code on the in-office laboratory testing and procedures list or with other non-laboratory testing/procedure services, the specimen handling and venipuncture codes will be considered for reimbursement.
Source: medicarepaymentandreimbursement.com

Electronic Billing & EDI Transactions

The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Source: cms.gov

Medicare, Medicaid and Medical Billing

When a Part A claim is processed by Medicare, Medicare pays the provider directly for the service rendered by the provider. On the other hand, in a Part B claim, who pays depends on who has accepted the assignment of the claim. If the provider accepts the assignment of the claim, Medicare pays the provider 80% of the cost of the procedure, and the remaining 20% of the cost is passed on to the patient. You should recognized that 80-20 breakdown: it’s a classic example of coinsurance.
Source: medicalbillingandcoding.org

Medical Billing and Coding

P. O Box 29127,  San Antonio, TX 78229 P, O, Box 31362, Salt Lake City, UT 84131 P. O. Box 400055, San Antonio, TX 78229 P. O. Box 659741, San antonio, TX 78265 P O Box 74080, Atlanta, GA 30374 P. O. Box 740818, Atlanta, GA 30374 UnitedHealthcare Provider Appeals  P.O. Box 30559 Salt Lake City, UT 84130-0559 UHC Medicaid Paper Claim Reconsideration request Addresses/Fax numbers UnitedHealthcare Community Plan AZ APIPA Claims PO BOX 5290 Kingston, NY 12402-5290 801-994-1224 UnitedHealthcare Community Plan CA PO Box 31365 Salt Lake City, UT 84131-0365 801-994-1224 FL UnitedHealthcare Community Plan M*Plus and Florida Healthy Kids (FHK) P.O. Box 31362 Salt Lake City, UT 84131 801-567-5497 HI UnitedHealthcare Community Plan P.O. Box 31350 Salt Lake City UT 84131-0350 801-567-5497 IA UnitedHealthcare Community Plan P.O. Box 5220 Kingston, NY 12402 801-994-1224 KS UnitedHealthcare Community Plan P.O. Box 31350 Salt Lake City UT 84131-0350 801-994-1224 NY UnitedHealthcare Community Plan P.O. Box 5240 Kingston, NY 12402-5240 801-994-1224 NM UnitedHealthcare CommunityPlan Centennial Care (includes Behavioral Health claims) PO Box 31348 Salt Lake City, UT 84131-1348 801-567-5497 MD UnitedHealthcare Community Plan PO Box 31365 Salt Lake City, UT 84131 801-994-1224 MS UnitedHealthcare Community Plan P.O. Box 5032 Kingston, NY 12402 801-994-1224 MI UnitedHealthCare Community Plan PO Box 30991 Salt Lake City, UT 84130-0991 801-994-1348 TN UnitedHealthcare Community Plan P.O. Box 5220 Kingston, NY 12402 801-994-1224 TX UnitedHealthcare Community Plan MMP/STAR PLUS: P.O. Box 31350 Salt Lake City UT 84131-0350 UnitedHealthcare Community Plan CHIP/STAR PO Box 5270 Kingston, NY 12402-5270 801-994-1224 PA UnitedHealthcare Community Plan PO Box 8207 Kingston, NY 12402 801-994-1224
Source: whatismedicalinsurancebilling.org

Medical Billing and Coding

Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Source: whatismedicalinsurancebilling.org

Medicare Billing for Well Woman Exam

1. Cervical High Risk Factors a. Early onset of sexual activity (under 16 years of age) b. Multiple sexual partners (five or more in a lifetime) c. History of a sexually transmitted disease (including HIV infection) d. Fewer than three negative pap smears within the previous 7 years 2. Vaginal Cancer High Risk Factors: DES (diethylstilbestrol) exposed daughters of women who took DES during pregnancy 3. Personal History of Health Hazards: If a patient has a specified personal history presenting hazards to health then apply the V15.89 diagnosis and the appropriate health history hazard (example: V10.3 History of Breast Malignancy).  Any V15.89 diagnosis is considered high risk and makes the patient eligible for the yearly G0101 and Q0091.
Source: capturebilling.com

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